Cabergoline is a once daily ergot-derived dopamine agonist, commonly used in Europe, but available in the United States for the treatment of hyperprolactinemia. Cabergoline has been evaluated in de novo and advanced PD populations. In a double-blind, 2:1 placebo-controlled trial of 188 PD subjects taking levodopa, the addition of cabergoline allowed for an 18% reduction in levodopa and a 16% improvement in motor scores (45). In a larger placebo-controlled comparison of 419 treatment-naive subjects randomized to receive either cabergoline (n = 211) or levodopa (n = 209), similar benefit was found (46). Motor complications were significantly delayed (P = 0.0175) and occurred less frequently with cabergoline than with levodopa (22.3% vs. 33.7%). Similar to other studies, the levodopa-treated subjects demonstrated significantly (P < 0.001) greater improvement in motor disability. Cabergoline-treated patients experienced a significantly higher frequency of peripheral edema (16.1% vs. 3.4%, respectively; P < 0.0001).

Clarke and Deane (47) compared cabergoline to bromocriptine in a meta-analysis of five randomized, double-blind, parallel-group studies in 1071 subjects. Cabergoline produced benefits similar to bromocriptine in off-time reduction, motor impairment and disability ratings, and levodopa dose reduction over the first three months of therapy. Dyskinesia and confusion were increased with cabergoline, but otherwise the frequency of adverse events and withdrawals from treatment were similar with the two agonists. Side effects of cabergoline are similar to other dopamine agonists, but also include severe restrictive mitral regurgitation and male sexual dysfunction (48).

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